We sat down earlier this year at Palooza 2024 with Rebecca Cady, 2023 President of the American Society for Health Care Risk Management (ASHRM) and VP / Chief Risk Officer of Children’s National Health System, to ask her about front-line barriers, enterprise risk management and connected healthcare operations and data.
Removing Barriers for the Front Line
“As a risk leader, it's really imperative for me to understand what really happens at the bedside and all the opportunities for silos to come up and miscommunications to happen, and uncertainties and the ways that people make errors are very clear to me, having been on the clinical end. And essentially I worked my way through law school as a nurse. So I saw that and then I continued to be able to observe these things as a lawyer, but kind of still through that clinician's lens.
“So these are the legal arguments, these are the legal impacts of what we're doing at the bedside, what we're putting in the chart, what we're saying to each other as care teams, and sometimes more importantly, what we're not saying to each other. And pull that all together and really see the impact of all the little things that we do as clinicians that we probably don't have a good feel for what the global potential consequences of those things are.
“And because we're seeing only what's in front of us, the task at hand on a given day, whether you're got to take a set of vital signs on a patient, or whether you're admitting a patient or whether you're getting a patient ready for surgery, you're focused on those things and rightfully, but it's important for folks who are doing those jobs to have an idea of the bigger picture and the impact of the care that they do.
“And on the other hand, as an administrator, if you don't have an acute awareness of what things are like on the front line, all the things that we've been talking about, workplace violence, staffing challenges, challenges that people are having in their own lives, people have lives outside of their job clearly. And I don't know that we necessarily think about that enough as administrators.
“What are we doing to really look at the whole employee and make sure that all the different administrative functions of the organization are focused on? What can we do to empower the front line to remove barriers to them providing the quality and safe care that they want to provide to our patients? And really kind of looking at it through that lens. Those are the things that I think are important about connecting the various disparate parts of healthcare and really having a global view of what's our end goal and what is everybody's role in achieving that and how do we eliminate the barriers for the front end of the house.”
Empowering the Front Line With Connected Healthcare Operations and Data
"Every little piece of the puzzle matters. And if we don't have good data, if we don't have reliable data, if we don't have timely data and the right kind of data, we can't answer the important questions that we need to answer in order to be able to maximize the ability of the organization to fulfill its mission and provide safe and quality healthcare to patients. And so every little bit of that matters.
“And whether you are inputting data or whether you are creating automated reports, whether you're looking at how can we optimize the platform to turn out the kinds of things that we need it to, asking those questions of yourself daily about what is the bottom line on this? How does this contribute to the organization moving forward?
“So what is the bottom line on this? How can I, as an individual employee, contribute to moving the organization forward? And in order to be able to do that, you have to understand what's our strategic plan, and then more importantly, what's our role in it. So I look at that, that's leadership job to convey those messages down to the front line. This is our goal, and these are the ways in which your work can impact that goal, either positively or negatively.
“So for the leaders in the room, I would say if you haven't looked at your strategic plan recently, do that. Put some thought to it and figure out, okay, what is my department's role in this? The success of the organization with this thing? If we have a patient safety goal, what is it that we can do to move that ball forward?
“And then going out into the organization, doing rounds, being visible, meeting with the frontline staff. I find it very powerful for people who work in data to go talk to the frontline staff and the frontline managers. So the nursing unit managers, the medical unit directors, what kind of data do they need? Or they might help them to do a better job to provide quality care and to provide safe care. And so then you can take that back.
“And then the art of your job then is to figure out, well, I know what the end product is that people are looking for. How do I get the database to the point where it can give the front end of the stick, the pointy end of the stick, those frontline bedside staff the information that they need in order to be able to do these things.”
Enterprise Risk Management as a Thought Partner
“Risk management professionals have a unique sort of place in the organization in that they're not necessarily responsible for operations. So you're not responsible in risk for making sure that patients get taken care of. You're not responsible for dropping the bills, you're not responsible for ordering the supplies. So you have the ability to sort of be like Switzerland. You can be a neutral party that looks at things in the organization and can ask those questions as to how might we work together in a better way to manage the risks of the organization and to help make sure that the organization is successful in meeting the goals in its strategic plan.
“At its highest expression, risk management is about managing the risk to the organization. And by what I mean by that is the existential risks. So if we can't execute on our strategic plan, we're not going to be around for very long. So patient safety and quality are an important key part of enterprise risk management. And we can do that because we are looking at it from a 35,000 foot view. We're not looking at it at a 5,000 foot view. So we don't really have a dog in the fight, so to speak.
“And the great thing about that is that risk can position itself to be really a thought partner with other pieces of the business to talk to operational departments about how can we help you operations person do your job in a way that's more efficient, more effective. And that helps us move the ball down the field in terms of meeting our strategic goals. So having the ability to, and I really encourage risk teams, whether you're a chief risk officer or not.
“As a risk professional, I highly encourage people to go have a meeting with your IT security lead. Go have a meeting with your finance people, go have a meeting with whoever's in charge of patient billing, in charge of patient relations, or the ombudsman or all these different areas of the hospital or people that you should go have coffee with. Figure out what keeps them awake at night, what are the big scary problems that they're dealing with? And figure out how you as the risk department can help them manage those problems.
“And it doesn't take any money to do that. It's just about time and attention. And over time, if you start to develop those relationships, you may find that if you're able to help somebody with a problem that they have, then maybe they'll start coming to you the next time they have another problem. And then you can start to gather more information.
“And then it just becomes kind of like this virtuous cycle where you've shown that you're not the department of no, that you're really there to be an internal subject matter expert, that you're there to sort of be the wind beneath everybody's sails and that you're helping people sort of lift up out of their operational details and really look at how is what they're doing impacting the overall organization.
“And it's my belief, and I think the data supports it, that organizations that do that are much more successful, not only from a financial standpoint, but also in terms of their ability to provide safe and effective healthcare.”
Accurate, Accessible, Actionable Data
“Executives are drowning in data. There's almost too much data and too little of it is really actionable. How do we make that better? Well, I think looking at beginning with the end in mind, as I think it was Stephen Covey used to say, right? So what are the things that executives are making decisions about on a daily basis? What are the key decisions? What are the key drivers of organizational success or failure? What data do we have in our potential data warehouse that can address those challenges and those decisions that need to be made?
“And then how do we make sure that first of all, the data's accurate? Because if it's not, then that's going to cause a whole host of problems. So accurate data that can be effectively pulled out in a way that provides actionable data. So it needs to be accurate, it needs to be easy to find, and it needs to be actionable. And that's a challenge. I think that everybody struggles with it.
“And there are so many different products on the market that say they do one thing and maybe they do, but a lot of it is on how do you set that product up in your organization? Because if you have processes that are not effective to begin with, and you load those into a system, then you just have lousy processes that are now automated that you can never get away from. So in adopting platforms, you need to really look at what are your processes? Are they best in practice? Are they really designed to get you the answers that you need and make sure that you're spending the time on the front end to get the system set up to where it's going to serve you.
“We need better data. We need data at our fingertips. We need real time data. And so making it on the front end, it should be easy to report. It needs to be safe to report, and it needs to make a difference. And so if we can get those three things in place and have staff reporting data that we need, then we can tackle the front end. Do we have the right kind of data? How do we pull things in from finance? How do we pull things in from patient statistics? How do we pull things in from our safety program? How do we pull things in from our HR and workers' comp program?
“Those things all leveraged together can make a profound impact in an organization, but it has to be done in a way that's thoughtful. And again, it has to be accurate and accessible and actionable.”
Investment From Leadership
“In general, from a change management standpoint, you have to make sure that you have all your stakeholders lined up to get ready and do it. And the organization needs to understand what's the time commitment going to be in order to be able to do this, right? And I think that's where risk has an important voice to say, Hey, if we're going to do this, if we're going to spend the money on something, we need to make sure to do it right.
“We don't want the treadmill in the corner being a very expensive, dirty laundry collector. If we're buying the treadmill, we want to get on that treadmill and run, and it needs to work and it needs to do what we need it to do. So the risk, I think, has an ability to influence these processes by helping folks understand that investment on the front end is important. And that's not just the investment of money, but it's the investment of time and attention and leadership. Buy-in.
“It's very important for the tone from the top to be, this is what we're going to do, this is the way we need to do it. It's going to take some time, but it's important for us to do it this way because the benefits of doing it this way will mean that we can fully utilize the platform, that we can ultimately make our work lives easier, that we can be bigger, stronger, faster, because we've got this very product working for us so that we can work at the top of our licenses.
“We don't want to have to have people doing tasks that they're much capable of doing much more. You don't want people doing menial work. So in order to do that, you need to put in the time on the front end and risk can be an important voice in making sure that that message is heard at the appropriate levels of the organization.”
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